Within-Day and Weekly Variations of Thrombolysis in Acute Ischemic Stroke: Results From Safe Implementation of Treatments in Stroke-International Stroke Thrombolysis Register Svetlana Lorenzano, Niaz Ahmed, Turgut Tatlisumak, Meritxell Gomis, Antoni Dávalos, Robert Mikulik, Petr Sevcik, Jyrki Ollikainen, Nils Wahlgren and Danilo Toni for the SITS Investigators Stroke. 2014;45:176-184; originally published online November 21, 2013; doi: 10.1161/STROKEAHA.113.002133 Stroke is published by the American Heart Association, 7272 Greenville Avenue, Dallas, TX 75231 Copyright © 2013 American Heart Association, Inc. All rights reserved. Print ISSN: 0039-2499. Online ISSN: 1524-4628
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Within-Day and Weekly Variations of Thrombolysis in Acute Ischemic Stroke Results From Safe Implementation of Treatments in Stroke-International Stroke Thrombolysis Register Svetlana Lorenzano, MD, PhD, MSc; Niaz Ahmed, MD; Turgut Tatlisumak, MD, PhD; Meritxell Gomis, MD, PhD; Antoni Dávalos, MD, PhD; Robert Mikulik, MD, PhD; Petr Sevcik, MD; Jyrki Ollikainen, MD; Nils Wahlgren, MD, PhD, FESO; Danilo Toni, MD, PhD, FESO; for the SITS Investigators Background and Purpose—Temporal variations of thrombolysis delivery and their influence on outcome have been reported with controversial results. In this large cohort study, we evaluated whether thrombolytic treatment has a within-day and weekly variability corresponding to circadian and weekly patterns of ischemic stroke onset, and whether these have impact on clinical outcome. Methods—We retrospectively analyzed patients with acute ischemic stroke receiving intravenous alteplase, prospectively included in the Safe Implementation of Treatments in Stroke-International Stroke Thrombolysis Register. Patients were grouped by treatment on day hours (08:00–19:59) or night hours (20:00–07:59) and treatment on weekdays and weekends. For each subgroup, we analyzed frequency of thrombolytic treatments, time intervals, and outcomes (3-month modified Rankin Scale score 0–2 as good functional outcome, mortality, symptomatic intracerebral hemorrhage). Results—We included 21 513 patients. Considering the mean expected number of patients treated per hour (0.4) and per day of the week (9.8), if no temporal variations were present, patients were significantly treated more during day hours and weekdays (P
The online version of this article, along with updated information and services, is located on the World Wide Web at: http://stroke.ahajournals.org/content/45/1/176
Permissions: Requests for permissions to reproduce figures, tables, or portions of articles originally published in Stroke can be obtained via RightsLink, a service of the Copyright Clearance Center, not the Editorial Office. Once the online version of the published article for which permission is being requested is located, click Request Permissions in the middle column of the Web page under Services. Further information about this process is available in the Permissions and Rights Question and Answer document. Reprints: Information about reprints can be found online at: http://www.lww.com/reprints Subscriptions: Information about subscribing to Stroke is online at: http://stroke.ahajournals.org//subscriptions/
Within-Day and Weekly Variations of Thrombolysis in Acute Ischemic Stroke Results From Safe Implementation of Treatments in Stroke-International Stroke Thrombolysis Register Svetlana Lorenzano, MD, PhD, MSc; Niaz Ahmed, MD; Turgut Tatlisumak, MD, PhD; Meritxell Gomis, MD, PhD; Antoni Dávalos, MD, PhD; Robert Mikulik, MD, PhD; Petr Sevcik, MD; Jyrki Ollikainen, MD; Nils Wahlgren, MD, PhD, FESO; Danilo Toni, MD, PhD, FESO; for the SITS Investigators Background and Purpose—Temporal variations of thrombolysis delivery and their influence on outcome have been reported with controversial results. In this large cohort study, we evaluated whether thrombolytic treatment has a within-day and weekly variability corresponding to circadian and weekly patterns of ischemic stroke onset, and whether these have impact on clinical outcome. Methods—We retrospectively analyzed patients with acute ischemic stroke receiving intravenous alteplase, prospectively included in the Safe Implementation of Treatments in Stroke-International Stroke Thrombolysis Register. Patients were grouped by treatment on day hours (08:00–19:59) or night hours (20:00–07:59) and treatment on weekdays and weekends. For each subgroup, we analyzed frequency of thrombolytic treatments, time intervals, and outcomes (3-month modified Rankin Scale score 0–2 as good functional outcome, mortality, symptomatic intracerebral hemorrhage). Results—We included 21 513 patients. Considering the mean expected number of patients treated per hour (0.4) and per day of the week (9.8), if no temporal variations were present, patients were significantly treated more during day hours and weekdays (P
